YouScript: Life Changing Analysis

Elise Astleford was afraid that she was developing Alzheimer’s disease. Moments of confusion and forgetfulness plagued her to the point where simple joys like playing a card game became daunting. “I would have to put the cards down so carefully, it was impossible to focus.”

As new prescriptions frequently made her feel worse, whenever doctors prescribed a new drug, Elise would prepare herself for another trial and error experience by scheduling days off from her life as a retired Episcopal priest, to give herself time to see what would happen.

Often, her system couldn’t tolerate the new drug and would experience what felt like an extreme allergic reaction. Medications prescribed for even the most common conditions gave her terrible side effects.

Unable to function as she once had, Elise resigned herself to the idea that these symptoms were a sign of getting older, and feared her episodes of dementia were early signs of Alzheimer’s disease.

After seeing an ad in a local publication, Elise sent a DNA sample to Genelex for drug sensitivity testing.

When her pharmacist ran her results and a list of the medications and over-the-counter drugs she was taking through the YouScript™ Personalized Prescribing System software, the problem became immediately clear. Astleford learned that she is an intermediate metabolizer of the cytochrome 2D6 and 2C19 enzymes.

The over-the-counter antihistamines Elise was taking contained the active ingredient, chlorpheniramine. Chlorpheniramine is metabolized by the CYP2D6 enzyme, and continued use would result in increased levels of the drug in her system, exposing her to possible adverse drug reactions that affect the central nervous system, such as dizziness, sedation, and altered mental states.

Her pharmacist advised she discontinue taking any medicines containing chlorpheniramine. She did, and the results were life changing. “It was like night and day. I feel like I got my life back.”

Now Elise runs everything by her pharmacist who uses YouScript™, “It is wonderful having a gifted pharmacist who understands that I am an intermediate metabolizer through two pathways and what that means.” Elise’s doctors, including her cardiologist, have now also received reports on which medications are safe or unsafe for Elise and what her proper dose is.

In September, Elise came to Seattle for a Genelex press conference where she told her story to TV and newspaper reporters. National and local news organizations covered the story, “All of a sudden I realized I wasn’t an old lady who was destined for a nursing home. My thinking is clearer and I have unexpected energy.”

Elise carries her YouScript™ card in her wallet, ready to tell her cautionary tale and encourages all healthcare providers to make pharmacogenetic testing the standard of care so fewer people will have to suffer through adverse drug reactions like hers.

These days, it’s not unusual to find Elise briskly walking along a park trail, playing a lively card game with friends or creating art. Her paintings are made into greeting cards which brighten the days of their recipients. It’s a far cry from the diminished quality of life she once thought she was destined for. □

Did You Know?

While dieticians, nurse practitioners, physician assistants, nurse midwives, and clinical social workers are recognized as healthcare providers under the Social Security Act, pharmacists are not, despite overwhelming evidence of their positive impact on patient health.

Change.Org is hosting a petition to correct this crucial oversight in healthcare policy.

Learn more and weigh in at: http://chn.ge/OyZcOS

Personalized Medicine May Fuel Economic Growth

The concept of personalized medicine isn’t new, but the public awareness campaign is only just picking up momentum, partly on the heels of the Patient Protection and Affordable Care Act (PPACA). While the overhaul of the American healthcare system is surrounded by considerable debate, biotech companies are finding fresh optimism in bringing the science of pharmacogenomics into the mainstream.

Though physicians and pharmacists are just beginning to adopt gene-based prescribing, it has already caught the eye of Eddie Yoon, a research analyst for Fidelity Investments and the company’s health care fund manager.

“We are entering the era of Biotech 2.0, in which targeted diagnostic tests are accelerating advances in the truly life-changing therapies of personalized medicine,” according to a recently published Fidelity Viewpoint article. “With an estimated 90% of prescription drugs working only about 50% of the time, prescribing physicians could use molecular diagnostics to test for specific genetic mutations that might cause one drug to be harmful, while another might be safe.”

Fidelity considers genetic-based medicine regimes a game-changing innovation that can drive considerable growth in the health care sector. And at a current estimate of 770,000 injuries and deaths from adverse drug reactions, Fidelity suggests,“this could not only save 50% of drug costs, but also help prevent a leading cause of unintended death.”

All this suggests that the cost savings introduced by personalized medicine and genetic-based prescribing practices might well become the prevailing catalyst to an entirely more patient-centric approach to healthcare. □

Whether it will be improved patient care goals or impressive profit-and-loss ratios that fuel the move to personalized medicine, all indicators point to a win-win scenario.

Source:  https://www.fidelity.com/viewpoints/personalized-medicine-revolution

Codeine For Kids? FDA Says Maybe Not

On August 15th, 2012, the FDA issued a Drug Safety Communication cautioning against the use of codeine in children following surgery. Four recent cases of severe adverse drug reactions prompted this communication.

In these cases doctors used the opioid narcotic codeine as a pain-killer following nose and throat surgery in children suffering from sleep apnea. Their ages ranged from 2-5 years old. All of the children received normal doses of codeine, however, respiratory symptoms developed within two days of starting the regimen. Three of the four cases proved fatal. 

Evidence suggests that all four children possessed the CYP2D6 Ultra-Rapid Metabolizer phenotype. Enzymes within the liver naturally convert codeine into morphine. However, in these particular cases the children’s livers would have converted the codeine more rapidly than expected, leading to dangerously high blood-morphine levels.

Recent studies have shown some aspects of opioid sensitivity (including decreased respiratory rate, sedation, and addiction risk) can be genetically inherited. It’s estimated that 7% of the population possess the aforementioned Ultra-Rapid Metabolizer phenotype, although its estimated to be as high as 29% of North African and Ethiopian populations.

Conversely, individual genetics may also cause opioids to be processed more slowly than expected. The FDA reminds readers that the only way to know if someone is an Ultra-Rapid Metabolizer is to do a genetic test that determines an individual’s CYP2D6 phenotype.

Codeine, along with other related opioids such as methadone and oxycodone, forms a cornerstone of advanced pain management, and is also used as a cough suppressant. Adverse reactions to codeine typically manifest as sleepiness, confusion, or breathing difficulty. Nausea is also common, affecting approximately one out of every three patients taking codeine post-surgery. Even non-serious side effects can be problematic, extending hospital stays and increasing likelihood of readmissions.

The FDA is currently investigating to determine if additional cases of severe adverse drug reactions have occurred in children. They advise healthcare professionals to be conservative in their prescribing regimens and remind parents to monitor their children’s health for any adverse drug reactions whenever taking new medications. □

Source: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm315497.htm

Washington Family Reunited

The Republic of the Union of Myanmar has been in political and economic turmoil for decades. Formerly known as Burma, the country had been under military rule until the beginning of 2011.

In 2008, Aum Phe attempted to smuggle his family out of the country, to escape religious persecution. Though he and his wife were able to get out of the country, Thailand border agents discovered the van transporting their five children and sent them back to Myanmar.
 

Since their separation, Aum and his wife, Shwe Pai, have been living in Washington state where he had, at least, found peace tending his backyard garden.

All of that changed on the night of Tuesday, July 18th when the couple’s children landed at the Tri-Cities Airport in Pasco, Washington. The children were greeted with hugs, strawberries, and bottles of Sprite and Coca Cola.

The two boys and three girls range in age from 7 to 16 years old. Om Phe, the oldest son, is now nearly as tall as his father. Speaking through a translator, Aum Phe, thanked everyone who made the reunion possible.

Before escaping, Aum Phe had to work for years to save enough money to get his family out of the country. He worked in India and Malaysia, taking whatever work he could find, including working for a pig farmer, where he slept in a field inside a makeshift tent made of newspapers and plastic tarps while earning little to no money.

When his children were prevented from fleeing the country, he had to bribe border agents to learn where they were and again to buy the release of his children, so they could return to their uncle’s farm.

Fortunately, Aum Phe’s story is uncommon with fewer than 6 percent of families becoming separated during their relocation, according to World Relief. The process to reunite the family took years of paperwork, an immigration attorney, DNA relationship testing, and a lot of worrying.

Over the years, the Phe’s sent money to Myanmar for their children to rent a home and for the two oldest to go to school and take English lessons. Now they look forward to sending all their children to school, and if all goes as planned, Aum wants to send Om Phe, 16, to college, and maybe take classes himself. □

FDA Reaffirms Plavix Black Box Label Decision

The US Food and Drug Administration (FDA) is standing by its original decision to update the Plavix label with pharmacogenetic information. A meta-analysis published last year in the Journal of the American Medical Association led by Michael Holmes of the University College of London, raised questions about whether the label changes were premature.

The FDA black box warnings are the strongest type of printed warnings put on prescription drugs. Many pharmaceutical companies and physicians believe black box warnings stigmatize a drug and lead to a decline in prescription rates. However, to date, there is no evidence of a meaningful relationship between the warning labels and any changes in demand.

The CYP2C19 enzyme converts Plavix into its active form. Pharmacogenetic testing identifies the amount of the enzyme a person creates and assigns a value ranging from poor to rapidmetabolizers. The FDA updated the label to inform doctors that poormetabolizers experienced a diminished response to the drug. In 2010, the FDA added the black box warning to highlight that poor metabolizers exhibited a higher cardiovascular risk following acute coronary syndrome or percutaneous coronary intervention (PCI) than normal metabolizers. Both warnings emphasized that pharmacogenetic tests could help guide therapeutic strategies, with the black box advising doctors to "consider alternative treatment strategies" in poor metabolizers.

Holmes et al noted “evidence of small-study bias” in the data collected by the original meta-analysis, and restricted their analysis to only four studies with 200 or more events. These four studies, plus six randomized trials, failed to identify any significant associations between CYP2C19 genotypes and Plavix efficacy in terms of cardiovascular events and bleeding.

According to Lawrence Lesko, former director of the Office of Clinical Pharmacology at FDA's Center for Drug Evaluation and Research, emerging data has shown that the FDA was right in updating the Plavix label. He noted that two other meta-analyses, published before the Holmes et al study, found that poor metabolizers were at heightened risk for cardiac events. Jessica Mega, a cardiologist at Brigham and Women’s Hospital authored a meta-analysis two years ago reporting Plavix-treated patients who were poor to intermediate metabolizers had a “significantly increased risk of major adverse cardiovascular events, particularly stent thrombosis.”

Scripps Health Chief Academic Officer, Eric Topol, has repeatedly argued that CYP2C19 pharmacogenetic testing is most useful in patients who have undergone PCI and are at risk of stent thrombosis. Many agree that these studies have been positive and that the resulting dialogue continues to be extremely valuable to doctors and patients. Ultimately, conversations like the Plavix/FDA debate continue to underpin the value of pharmacogenetic testing in treatment strategies.  

Did You Know?

More than 50% of the most commonly prescribed drugs are processed by enzymes whose levels vary due to genetic factors. This genetic variability is a leading cause of adverse reactions.

There are over 2 million severe adverse drug reactions every year.

Every day more than 5,000 Americans have  an adverse drug reaction serious enough to require hospitalization.

In 2001, the direct healthcare costs associated with adverse drug reactions were estimated at $177 billion.

Personalized Prescribing in Action: Case Study

You don’t need genetic information to benefit from YouScript™!

A 62-year-old male doctor whose health conditions, at the time, included hyperlipidemia, erectile dysfunction, dental carries, and insomnia. His daily medications consisted of aspirin, Lipitor, Viagra (as needed), and chlorhexidine mouth rinse, also valerian root, melatonin, and Benadryl for sleep. Along with coffee and energy drinks, the subject had been taking over-the-counter medications including: fish oil, coenzyme Q10, Niacin 1000mg, L-carnitine, Voltaren gel (purchased from Mexico) and IBU 400-600 mg daily as needed for need pain. He had no known drug allergies.

His ophthalmologist instructed him to start taking the over-the-counter herbal medications Wobenzyme, red yeast rice, curcumin powder, and grape seed as supplements.

Soon after adding the supplements to his daily regimen, the doctor began to experience muscle aches, pains, and flu-like symptoms.

Unfortunately, the ophthalmologist had advised the doctor to take substances that interacted with the prescribed medications he was taking. The interactions were severe and based on the report may have been early signs of rhabdomyolysis.

Had either the doctor or the ophthalmologist utilized YouScript™ prior to initiating the OTC herbals, they would have seen the following interactions:

·         Red yeast rice contains the compound lovastatin which is in the same class of drugs as Lipitor. The subject was already on high dose Lipitor. This combination alone could have resulted in the adverse reactions described. This combination is not advised.

·         Levels of lovastatin may be increased up to 150% by grape seed due to 3A4 inhibition. Levels of Lipitor might also be increased but to a lesser extent. This interaction could also help explain the adverse reaction the patient had.

·         Clinical studies show that co-administration of niacin and lovastatin has been found to increase the risk of rhabdomyolysis. The lovastatin product insert recommends no more than 20 mg daily when niacin levels exceed 1 gram per day – however, since the patient was taking lovastatin in a non-standardized form, it is unknown how much he was truly receiving.

Once the doctor stopped taking the drugs and herbal preparations recommended by his ophthalmologist, the problems resolved.

You don’t need a patient’s genetic information to benefit from YouScript™. It is a powerful algorithm-based program that can help patients and practitioners predict clinically significant drug interactions before they happen. YouScript™ predictions are based on clinical studies and the most up to date expert opinions in the field.

Identifying Twins: DNA Straight Talk

Some may not see the value in knowing the difference between identical and fraternal twins, but to the parents of twins, it can matter a great deal. It’s a part of their children’s identity.

Unfortunately, according to a new study, a fair number of parents were misinformed due to a common misconception that twins who gestate in separate placentas are fraternal. Actually, 25-30 percent of identical twins have separate placentas and amniotic sacs.

A 2004 survey among members of the American College of Obstetricians and Gynecologists found that 81 percent of doctors were under this misconception. This new study, published in the journal BJOG this past February, showed 14.7 percent of  the 1,302 parents of same-sex twins were misinformed that their twins were either identical or fraternal.

The type of twins was confirmed through DNA testing, which may be a lesson learned for the future. With the availability, accuracy, and simplicity of DNA testing, the “rule of thumb” no longer need apply.

“I think there are a lot of parents who just want to know. A lot of parents finding out later on felt they just didn’t know their own children.” -Abi Fisher,an author of the study

New Look, New Brand, and New Pharmacists

After more than a decade, the medical and insurance communities are beginning to embrace DNA-based analysis as a powerful tool in selecting and optimizing pharmaceutical treatments. Genelex has been a consistent front-runner in these technologies.

GeneMedRx and our drug sensitivity tests are combining under our new YouScript™ brand. Over the next few months, you’ll notice changes in our informational materials and a major upgrade to our services.

Tyler Mamiya & Paul Verbeurgt  

For those who haven’t taken advantage of GeneMedRx, our new YouScript™ Personalized Prescribing System is a comprehensive, long-term solution for safer, more targeted prescribing. Most patients taking a series of drugs have genetic variations that affect their ability to process those drugs – to either eliminate or activate them. This includes most classes of routinely prescribed drugs, over-the-counter medicines, many herbal preparations, and some dietary supplements and foods. Cytochrome P450 testing detects those genetic variations.

Now, whenever a major or significant drug-drug or drug-gene interaction risk is noted, YouScript™ will generate a medication advisory report including potential alternative drug or dosing recommendations based on the patient’s DNA test results and overall medication regimen.

To bring more clarity to the prescribing process, we have a new team of clinical pharmacists: Paul Verbeurgt and Tyler Mamiya. They are busy analyzing patient medication regimens, DNA test results, and recommending specific actions to help improve prescribing outcomes. They are available to help prescribers, patients, and other pharmacists understand specific cases and to guide users in getting the most out of the YouScript™

system.

We’re celebrating the evolution of our state-of-the-art personalized prescribing services. We encourage you to join in the excitement, and the opportunity to improve patient care, by taking advantage of our new services today!

Happy Holidays from everyone at Genelex!

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Pharmacogenomics in Clinical Practice: Where Do We Go From Here?

In an interview with Medscape, Mark J. Ratain, MD, Professor of Medicine at the University of Chicago and Founding Director of the University's Center for Personalized Therapeutics, pointed out that pharmacogenomic testing needs to move from the realm of reflex lab testing to part of the physical exam….

“I think we need to take genetic testing out of the domain of laboratory testing and move it to the domain of physical examination. It can then be one more piece of information for the physician to consider and we wouldn't need to focus on the cost.”

“There are a lot of things we do during a physical examination that have never been demonstrated to be cost-effective. Physicians look at their patients' toes as part of an annual physical. Have you ever seen a study that shows that looking at your toes is cost-effective?”“We need to conceptualize genetic testing as a part of the physical exam rather than as a laboratory test that needs to be ordered so you can have the information at the time you are seeing the patient. For example, if you're starting a patient on warfarin, or you are considering whether to start him on warfarin, and you already know that he is going to metabolize warfarin a lot more slowly or that he's going to be a lot more sensitive to it, you can take that into account in the same way you would probably use a lower dose if your patient were frail or elderly. That is where I think the field needs to move.”

“The solution is one that we are piloting here, which is to genotype all patients for all polymorphisms that may affect drug response. You'll then have the results when you need them and your costs will be much lower than doing each test as a one-off laboratory test.
In the current system, you see the patient and want to prescribe a drug, and you say to yourself, ‘Maybe I should order a pharmacogenetic test. But I don't know how to do that, I don't know how long it is going to take to get results, and I don't know if my patient is going to get reimbursed for it. Oh, who cares. I am just going to prescribe the drug.'

“Unless someone says that you can't prescribe the drug without doing the test, or unless we change the way we look at how pharmacogenomic testing should be incorporated into clinical practice, the system is unlikely to change.”

DNA in the News

Another case-control study published in October pointed out increased risk of stent thrombosis for patients taking Plavix with variations in a gene called CYP2C19. Patients with adverse events were two times more likely to have half of the gene be non-functional. Called intermediate metabolizers, this represents about one-third of patients. Patients with no CYP2C19 function, called poor metabolizers, were seven times more likely to have an adverse event. About 2-4% of Caucasians, 10% of Africans, and 20% of Asians are poor metabolizers. If you or a loved one is taking Plavix, ask about DNA Drug Sensitivity Testing.

See more at theheart.org/article/1300023.do

Bringing Personalized Prescribing to the Community Pharmacy

An interview with Brian Hocum, PharmD of Wasem’s Pharmacy who has recently made personalized prescribing available to at-risk customers.

Why do you think genetics is important?
I tell my patients that through DNA technology, we are able to determine what type of drug metabolizer they are. I explain how this information can be used to help predict if they are at risk of having bad reactions to drugs (too much drug exposure) or poor response to drugs (too little exposure to the medication). Genetics is important because it allows Health Care Providers, like myself, to predict who will have “bad reactions” or “poor responses” to medications.

How would you define personalized prescribing in your own words?
‘Personalized prescribing” is the analysis and incorporation of patient specific factors (i.e. CYP450 metabolizing capacity–derived from DNA testing) prior to prescribing, dispensing and/ or choosing new medications (including OTC, vitamins, herbals) and doses. While we typically think of “prescribing” as something only Physicians do, I feel “personalized prescribing” is something we can all embrace; Physician, Pharmacist & Patient.

Why did you decide to launch this program at Wasem’s?
As a Pharmacist working in a community pharmacy, my number one goal is to serve the patients of the community. Our services are what bring patients into the store and they are what keep them coming back for years. Keeping patients safe through more informed medication and dose choices is the best service we can provide and “personalized prescribing” is the best tool I know of to do so.

What efforts have you made to educate physicians and patients in your community about personalized prescribing?
We have in the past and continue to educate the community through newspaper advertisements, co-marketing posters and speaking with community volunteer groups like the Rotary, Lion’s club and retirement centers.

Since pharmacists are able to order laboratory tests in Washington State for the purpose of monitoring drug therapy, I often find that the prescribers are unacquainted with “personalized prescribing.” I send them a fax describing what the genetic results mean, and any alternate medications or dose adjustments that they might considered based on the results. The response has been all positive. Doctors are noting the recommendations in their patient charts. I plan to host a dinner soon for Health Care Providers to educate them about “personalized prescribing.”

You have now made several successful interventions on a patient’s behalf; can you share one of these stories?
Yes, here is one of the first testimonials I received after a successful pharmacogenetic intervention. This patient struggled with adverse drug reactions her whole life, and was relieved that science and technology are finally beginning to understand and incorporate “personalized prescribing:”

“Thank you so much for guiding me through the new way to approach medication. Armed with the letter to my health care provider, I feel confident that finally my doctor will be able to adjust some of my medications. Maybe some day genetic testing will be a routine procedure before prescribing meds. How much misery and money could be saved if we get it right the first time…”

Did You Know?

In March of 2010, the FDA put a warning on the Plavix (clopidogrel) product insert that patients with a certain DNA variation of CYP2C19 (pronounced sip-2C19) were at high risk of treatment failure resulting in major cardiac problems or even death.

CYP2C19 is not just involved in Plavix metabolism, it is involved in the metabolism of ~10% of medications.

Other common medications processed by CYP2C19 include:
· voriconazole
· Prilosec
· Prevacid
· Aciphex
· Nexium
· Soma
· Lexapro
· Silenor
· Dexilant

Embassies Crack Down on Third-party Immigration DNA Tests

Third-party resellers of DNA testing abound on the internet. Unfortunately, many of them are unfamiliar with strict requirements for immigration DNA testing. The problem has become so pronounced that many Embassies are now requiring petitioners to contact AABB-accredited laboratories directly.

Natalie Messelt from the US Embassy in Addis Ababa stated, “A petitioner must independently choose his or her own AABB lab, make the appointment, and go to the collection site directly. The collection site must then send the specimen to the main AABB lab testing site directly,
through the lab's internal, controlled system. Third-party vendors include, but may not be limited to, private companies or clearinghouses that serve as intermediaries to make appointments on behalf of petitioners or beneficiaries. The authority for collecting DNA specimens in the United States resides exclusively with the AABB labs and their directly affiliated collection sites.”

The immigration process is complex and lengthy, don’t risk delays and unneeded additional expenses of retesting – contact the AABB labs directly.

Personalized Prescribing: Making the Most of Medicare Preventive Services

Many people don’t realize that personalized prescribing based on DNA testing is covered by most public and private insurers if a healthcare provider believes it is medically necessary. Be sure to ask about personalized prescribing at your next annual wellness visit.

Medicare offers a number of preventive services, including a free annual wellness visit so your doctor can identify health risk factors and recommend steps you can take to reduce those risks. Your doctor will evaluate your personal and family medical history, as well as current medications, and order tests. (See page 3 for complete description.) The goal of these visits is to prevent disease and to improve your overall health and well-being.

More and more physicians are including medication risk assessments to identify drug side-effects and interactions that may be causing problems along with the standard risk assessments for depression, heart disease, and cancer. If you’re taking four or more prescription drugs or one, such as Plavix, with a warning about genetics on the label, your doctor may order DNA Drug Sensitivity Testing to help optimize your prescriptions. Typically covered by insurance if ordered by a qualified healthcare provider, personalized prescribing helps doctors determine both “drug-to-drug” and “drug-to-DNA” interaction risk.

The comprehensive personalized prescribing program analyzes all the prescription drugs, herbal preparations, and over-the-counter medicines patients are taking for their combined interaction risk, and for their compatibility with a patient’s unique DNA profile.

“With this tool, no longer is it a trial and error proposition as to what drug and dose to prescribe; we can now do it scientifically with a much better outcome for the patient.”

- J.E. Block, MD, FACP, Tulsa, Oklahoma

As the number of drugs an individual is taking goes up, so do the risks of a serious or even fatal reaction. If these drugs are being prescribed by more than one doctor, are self-prescribed, such as herbals, or purchased from more than one source, the risks go up even more.

A questionnaire is now available that allows patients to quickly calculate their risk for adverse drug reactions and treatment failures to help determine if they are a candidate for DNA Drug Sensitivity Testing and a Personalized Prescribing evaluation. Based on information compiled from NIH, the FDA, and www.medsandaging.org, you can download the questionnaire at www.HealthandDNA.com/risk.pdf or request copies for yourself or a medical office by calling 800-523-3080 now.

Sources: U.S. Centers for Disease Control and Journal of the American Medical Association

DNA in the News

Caltech researchers recently developed an artificial neural network from human DNA molecules. They chose DNA molecules because they can act like circuits, computing data, transmitting information and processing it. The team then tested the intelligence of their creation with a series of trivia questions– the test tube brain scored 100%. Learn more in the July 21^st issue of the journal Nature.

DID YOU KNOW?

Human beings differ only in 0.1% of their overall DNA; in the other 99.9%, they are identical. One of the ways our DNA differs the most is in the coding for the enzymes that process the majority of the most commonly prescribed drugs. These enzymes vary more than any others known.
________________
A complete 3 billion base genome would take only 3 gigabytes of storage space, which would fit on memory cards now commonly used in many digital cameras.
________________
The codeine product insert warns that nursing mothers may cause harm to their babies if ,like 7% of the population, they have duplications of a gene called CYP2D6.

What is the Medicare Preventive Visit?

The information provided is directly quoted from Medicare.gov

The "Welcome to Medicare" preventive visit helps you and your doctor develop a personalized plan to prevent disease, improve your health, and help you stay well. A few things you should know:

· It's free. There’s no copayment or deductible for the visit.

· It’s easy to use this benefit. Just call your doctor when you sign up for Medicare.

· You can sign up for the visit during the first 12 months you have Medicare. After the first year, you can get a yearly “Wellness” visit for free.

· It’s comprehensive. The visit includes a review of your medical history, preventive tests and screenings, and planning for a healthy future.

· The visit is covered by Original Medicare (Part B) and Medicare Advantage Plans. Under

the new healthcare law, the visit is now free along with a number of preventive screenings and services (like mammograms and colonoscopies).

What should I expect during the visit?

During the visit, your doctor will:

· Record and evaluate your medical and family history, current health conditions, and prescriptions.

· Check your blood pressure, vision, weight, and height to get a baseline for your care.

· Make sure you're up-to-date with preventive screenings and services, such as cancer screenings and shots.

· Order further tests, depending on your general health and medical history.

Following the visit, your doctor will give you a plan or checklist with free screenings and preventive services that you need.

What you should bring to your "Welcome to Medicare" preventive visit:

· Medical records, including immunization records. Even if your current doctor does the visit, gather as much medical information as you can to make sure nothing is overlooked.

· Family health history. Try to learn as much as you can about your family's health history before your appointment. The information will help you and your doctor better understand what screenings you should get and what to watch for in the future.

· Prescription drugs. Bring a list of any prescription drugs, over-the-counter drugs, vitamins, and supplements that you currently take, how often you take them, and why.

Don't delay. Schedule your annual preventive wellness visit today! Ask your healthcare provider, or visit www.medicare.gov for more details.

Healthcare Provider? Ready to Make
Personalized Prescribing Part of Your Practice?
Contact Genelex at 800-523-3080 and ask for a Medical Accounts Specialist. We can help you take the guesswork out of prescribing at no cost to your patients or your practice.

Patient? Is Personalized Prescribing Right for You?
Contact Genelex at 800-523-3080 or visit www.HealthandDNA.com.